Insight Into Early Recurrences After Pulsed-Field Ablation for Atrial Fibrillation: Results From a Multicenter Experience

Background: Factors contributing to early recurrence after atrial fibrillation (AF) ablation, particularly with pulsed-field ablation (PFA), are poorly understood. Purpose: This study aimed to evaluate the significance of early recurrence and identify factors associated with its occurrence, focusing on predicting late recurrence in AF patients treated with PFA. Methods: A total of 620 consecutive patients referred for their first paroxysmal or early persistent AF ablation underwent the procedure using the FARAPULSE PFA system (Boston Scientific) across 10 centers. Early recurrence was defined as atrial arrhythmia of > 30-s duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence. Results: In total, 44 (7.1%) patients experienced early recurrences (median time to recurrence: 56 [22-75] days). At multivariate logistic analysis adjusted for baseline confounders larger left atrial volume index (LAVi) (1.03, 1.01-1.06, p = 0.0034) was significantly associated with early recurrences. In total, 113 (18.2%) patients experienced late recurrences. Factors independently associated with late recurrences included age (1.03, 1.01-1.05, p = 0.0077), sleep apnea (3.17, 1.73-5.81, p = 0.002), and early recurrences (3.26, 2.01-5.29, p < 0.0001). Early recurrences were associated to late recurrences also in paroxysmal AF only patients (40.0% vs. 16.9%, p < 0.0001). Conclusion: In this cohort of AF patients undergoing PFA, early recurrences significantly increased the risk of late recurrences, highlighting their potential as a predictive marker for long-term outcomes. Moreover, larger LAVi was associated with early recurrences. Trial registration: Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/. Identifier: NCT05617456.